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One vaccine to wipe out ALL mosquito-borne diseases? It’s in clinical trials

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(credit: CDC)

It’s hard to imagine anything more despised than mosquitos. They menacingly buzz about, swoop in to feast on your blood, and often leave behind an annoying, itchy lump. But by far the worst bit is that they spread throngs of pathogens—dengue, Zika, chikungunya, yellow fever, West Nile, malaria… the list goes on. Their bites cause hundreds of millions of infections each year. Dengue alone infects around 390 million people a year globally. Malaria strikes around 214 million.

What if there was a vaccine that could, in one fell swoop, prevent all of those infections? As a bonus, what if it could also prevent itchy responses to mosquito bites and even knock back the bug’s populations? It sounds like a dream. But SEEK, a UK-based biotech company, and the US National Institutes of Health are hoping it could be a reality some day.

This week, the NIH announced the start of a Phase I clinical trial for a vaccine that’s designed to do all of that. It’s called AGS-v, and it has been in the works for nearly a decade. It takes an approach to disease blocking that scientists have danced around for decades but never pulled off—it targets the saliva of mosquitos instead of any individual germ.

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francisga
10 hours ago
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Lafayette, LA, USA
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Women in Roman Times

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SPQR: A History of Ancient Rome by Mary Beard explains that women were expected to get married (see quote below).

Roman marriage was, in essence, a simple and private business. Unlike in the modern world, the state played little part in it. In most cases a man and a woman were assumed to be married if they claimed that they were married, and they ceased to be married if they (or if one of them) claimed they no longer were. That, plus a party or two to celebrate the union, was probably all there was to it for the majority of ordinary Roman citizens. For the wealthier, there were often more formal and more expensive wedding ceremonies, featuring a relatively familiar line-up for such a rite of passage: special clothes (brides traditionally wore yellow), songs and processions and the new wife being carried over the threshold of the marital home. Considerations of property bulked larger for the rich too, in particular a dowry that the father of the bride provided, to be returned in the event of divorce.

The main purpose of marriage at Rome, as in all past cultures, was the production of legitimate children, who automatically inherited Roman citizen status if both parents were citizens or if they satisfied various conditions governing ‘intermarriage’ with outsiders.

Just as today, however, being married did not necessarily limit a woman’s freedom:

No less problematic is the competing image, prominent in the first century BCE, of a new style of liberated woman, who supposedly enjoyed a free social, sexual, often adulterous life, without much constraint from husband, family or the law. Some of these characters were conveniently dismissed as part of the demi-monde of actresses, showgirls, escorts and prostitutes, including one celebrity ex-slave, Volumnia Cytheris, who was said to have been the mistress at one time or another of both Brutus and Mark Antony, so sleeping with both Caesar’s assassin and his greatest supporter. But many of them were the wives or widows of high-ranking Roman senators. The most notorious of all was Clodia, the sister of Cicero’s great enemy Clodius, the wife of a senator who died in 59 BCE, and the lover of the poet Catullus, among a string of others. Terentia is rumoured to have had her suspicions about even Cicero’s relations with Clodius’ sister. She was alternately attacked and admired as a promiscuous temptress, scheming manipulator, idolised goddess and borderline criminal.

Women were not shut away:

Women also regularly dined with men, and not only the sex workers, escorts and entertainers who provided the female company at classical Athenian parties. In fact, one of the early misdeeds of Verres turned on this difference between Greek and Roman dining practices. In the 80s BCE, when he was serving in Asia Minor, more than a decade before his stint in Sicily, Verres and some of his staff engineered an invitation to dinner with an unfortunate Greek, and after a considerable quantity of alcohol had been consumed they asked the host if his daughter could join them. When the man explained that respectable Greek women did not dine in male company, the Romans refused to believe him and set out to find her. A brawl followed in which one of Verres’ bodyguards was killed and the host was drenched with boiling water; he was later executed for murder. Cicero paints the whole incident in extravagant terms, almost as a rerun of the rape of Lucretia. But it also involved a series of drunken misunderstandings about the conventions of female behaviour across the cultural boundaries of the empire. Some of the legal rules that governed marriage and women’s rights at this period reflect this relative freedom. There were, it is true, some hard lines claimed on paper. It may have been a nostalgic myth that once upon a time a man had the right to cudgel to death his wife for the ‘crime’ of drinking a glass of wine. But there is some evidence that the execution of a wife who was caught in adultery was technically within the husband’s legal power. There is, however, not a single known example of this ever happening, and most evidence points in a different direction. A woman did not take her husband’s name or fall entirely under his legal authority. After the death of her father, an adult woman could own property in her own right, buy and sell, inherit or make a will and free slaves – many of the rights that women in Britain did not gain till the 1870s.

The only restriction was the need for an appointed guardian (tutor) to approve whatever decision or transaction she made. Whether Cicero was being patronising or misogynistic or (as some critics generously think) having a joke when he put this rule down to women’s natural ‘weakness in judgement’ is impossible to tell. But there is certainly no sign that for his wife it was much of a handicap: whether she was selling a row of houses to raise funds for Cicero in exile or raking in the rents from her estates, no tutor is ever mentioned. In fact, one of the reforms of Augustus towards the end of the first century BCE or early in the next was to allow freeborn citizen women who had borne three children to be released from the requirement to have a guardian; ex-slaves had to have four to qualify. It was a clever piece of radical traditionalism: it allowed women new freedoms, provided they fulfilled their traditional role. Oddly, women had much less freedom when it came to the act of marriage itself. For a start, they had no real option whether to marry or not. The basic rule was that all freeborn women were to be married. There were no maiden aunts, and it was only special groups, such as the Vestal Virgins, who opted, or were compelled, to remain single.

Being a virgin might have been a wise career choice:

The production of children was a dangerous obligation. Childbirth was always the biggest killer of young adult women at Rome, from senators’ wives to slaves. Thousands of such deaths are recorded, from high-profile casualties such as Tullia and Pompey’s Julia to the ordinary women across the empire commemorated on tombstones by their grieving husbands and families. One man in North Africa remembered his wife, who ‘lived for thirty-six years and forty days. It was her tenth delivery. On the third day she died.’ Another, from what is now Croatia, put up a simple memorial to ‘his fellow slave’ (and probably his partner), who ‘suffered agonies to give birth for four days, and did not give birth, and so she died’. To put this in a wider perspective, statistics available from more recent historical periods suggest that at least one in fifty women were likely to die in childbirth, with a higher chance if they were very young.

most of their contraceptive efforts were defeated by the fact that ancient science claimed that the days after a woman ceased menstruating were her most fertile, when the truth is exactly the opposite.

The best estimate – based largely on figures from comparable later populations – is that half the children born would have died by the age of ten, from all kinds of sickness and infection, including the common childhood diseases that are no longer fatal. What this means is that, although average life expectancy at birth was probably as low as the mid twenties, a child who survived to the age of ten could expect a lifespan not wildly at variance from our own. According to the same figures, a ten-year-old would on average have another forty years of life left, and a fifty-year-old could reckon on fifteen more. The elderly were not as rare as you might think in ancient Rome. But the high death rate among the very young also had implications for women’s pregnancies and family size. Simply to maintain the existing population, each woman on average would have needed to bear five or six children. In practice, that rises to something closer to nine when other factors, such as sterility and widowhood, are taken into account. It was hardly a recipe for widespread women’s liberation.

More: read SPQR: A History of Ancient Rome

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francisga
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The Benedict Option in Practice: Living the Rural Life is Surprisingly Normal

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Some tend to treat a move to the country as if it is a move to something wildly different from “normal” life.  As someone who lives in the country, I have an opinion there, but first – a lot of people are talking about rural life these days, so where did all this talk come from?

A lot of the conversations seem to stem from Rod Dreher’s idea that Christians take a “Benedict Option”, which as I understand it seems like the simple proposal that we continue to engage the world for Christ, yet ensure that we have enough space, especially for our families, that allows for a Christian culture to really exist and grow, instead of living in constant reaction to the increasingly hostile world around us.  Or something like that.

The whole idea seems to have struck a nerve since so many people have weighed in on it.  And despite the fact that Mr. Dreher has repeatedly insisted it is not a retreat from the world, people cannot help but think it means (a) retreat in defeat and (b) you should probably retreat to the countryside and be a farmer.  He has a book coming out on it soon – perhaps the critics will read it?

Benedictine Renewal

Dreher was responding to hostile and ugly secularism, and blogging Christians have responded to the response, offering alternative “options” to help persuade all those poor saps that are running to the hills and “hunkering down” in the Benedict Option.  I’ve heard of the Francis option, the Jeremiah option, and the St. Josemaria option.  All of them basically saying don’t retreat – engage!  Perhaps the authors hope their “option” will get as much play as Mr. Deher’s, but all of them, Benedict Option included, are simply Christians doing the necessary discernment of “how much am I in the world but not of it?”

I’d point out that the reason the “Benedict Option” resonates more than others is because of the fact of Benedictine renewal.  It was the Benedictines that had so much to do with preserving civilization and renewing culture in the midst of darkness after the collapse of the Roman Empire and the birth of Christendom.  It’s a historical reality recognized and written about by, among others, Alasdair MacIntyre (where Dreher got the idea), Christopher Dawson, Bl. John Henry Newman, G.K. Chesterton, Dorothy Day (an oblate) and her coreligionist Peter Maurin, John Senior (an oblate), and not to mention Pope Benedict XVI, who I think is pretty clear-sighted on problems and solutions.

What’s So Special About St. Benedict?

I once asked an abbot of a monastery why it was that the Benedictines have been so central to renewal – the rule they live by, after all, says nothing about keeping the outside world afloat.  “It is a practical and doable rule centered completely on God,” he said.  “We orient all of life and work in that direction and it seems the world around us follows.”  Sounds good enough to me.

Perhaps Carrie Gress, a philosophy professor at Pontifex University, has put the whole “option” thing to rest by proposing the “Marian Option”.  I mean, c’mon, can any other option be as good as Mary’s?  Dr. Gress explains:

The Marian Option, unlike the Benedict Option, doesn’t generally require anything drastic, like significant changes in one’s community, occupation, or location (although she may inspire you to do these later). What it does require is simply the full and active recognition that she is our mother and, therefore, a tremendous advocate of grace, protection, conversions, and victories through the rosary.

In my experience men who give themselves over to Marian devotions wholeheartedly actually tend to have significant changes in community, occupation, and location.  In fact, only weeks after I made a Monfort style Marian Consecration, all of those things changed for me.  But, my point again here is this – going to the country is not necessarily “drastic”,  and moving to the countryside is perhaps a decidedly tame option.

As someone who is “out there”, I’d like to offer a few observations – dispatches from the Benedictine Option if you will.  Again, it seems that Dreher is trying to tamp down the “run to the hills” mentality, and I do live in the hills, but perhaps the vantage point from the hills – the cliché depiction – can help us to see the issue a bit clearer.

What Being a Country Catholic is Really Like

First, people live out here too.  And they have souls.  I have near daily contact with people, but it is deeper and more meaningful contact that my experience in a city.  We are conscious of being neighbors, unlike the stacks of people in apartments that don’t move past polite smiles (if that).   (Really, I’m not attacking apartment dwellers – this is an observation from my experience.)  Friends I’ve made out here are coming into the Church, especially because we have a parish of beauty and solid preaching.  Evangelization does not require a consolidated population.

Second, nature is great.  Humanity is a part of nature, we are nature’s stewards, and living in close proximity is living in the most “normal” of settings.   As G.K. Chesterton once noted, the city is the only habitat where people have to leave (i.e. visit the countryside) to have a retreat.  Living close to it helps us to see and feel our relation to it, which helps to temper the extreme and anti-life sentiments that view humanity as a total drain on nature’s goodness and therefore it would not be all that bad if we self-exterminated, perhaps starting before birth even.

Third, homesteading is a great reward, but it also draws you to your neighbor.  Nearly everyone has some kind of contact with land in the country, whether a cousin cuts hay from the land, most keep a small garden, and a few keep a pig to eat scraps.  There’s a lot of overlap, but the different things people “specialize” in draw them together for bartering and the pure gift of sweet corn.

Let me just correct too that “we can’t all be farmers” comment.  Removed from land and season and weather for a generation or more leaves people removed from the tradition of farming, the culture of agriculture.  In other words, you can’t be a farmer not because it’s not a good option or its reactionary, but because you don’t know how, and you likely cannot get it halfway figured for years.  People dismiss “running away to be farmers” as if farming were just one more complex system they could arrange into success like strategically choosing stocks.  This shows how little they know of it, and how little they think of farmers.

So, maybe we can’t all be farmers, but for those of you that want to venture toward land and neighbor, come on.

Jason Craig works and writes from a small farm in rural North Carolina with his wife Katie and their five kids. Jason is Director of Program and Training for Fraternus, a mentoring program for young men, and holds a masters degree from the Augustine Institute. He is known to staunchly defend his family’s claim to have invented bourbon.

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francisga
19 hours ago
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roachpatrol: astercrash: Did anyone notice how quickly the internet turned into a Lovecraftian...

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roachpatrol:

astercrash:

Did anyone notice how quickly the internet turned into a Lovecraftian horror scenario?

Like we’ve got this dimension right next to ours, that extends across the entire planet, and it is just brimming with nightmares. We have spambots, viruses, ransomware, this endless legion of malevolent entities that are blindly probing us for weaknesses, seeking only to corrupt, to thieve, to destroy.

Add onto that the corrupted ones themselves, humans who’ve abandoned morality and given up faces to hunt other people, jeering them, lashing out, seeing how easy it is to kill something you can’t touch or see or smell. They’ll corrupt anything they think could be a vessel for their message and they’ll jabber madly at any who question them. Their chittering haunts every corner of the internet. They are not unlike the spambots in some ways.

Add on top of that the arcane magisters, who are forever working at the cracks between our world and the world we made. Some of them do it for fun, some of them do it for wealth, others do it for the power of nations unwise enough to trust them. There are mages who work to defend against this particular evil, but they are mad prophets, and their advice is almost never heeded, even by those who keep them as protection.

All people know several spells to use the internet. Facebook asks you for the magic words to log in, so does your email, so does your twitter and on and on. The spells are words or a gesture with the hand, some use the colour of your eyes, or the shape of your finger. Our chief of security joked about requiring users to give a drop of blood before they could log in. Many do not understand the humour of mages.

The cracks between the two are breaking. IP cameras filled our world with eyes and the magisters learned how to open almost all of them. We all carry magic slabs of glass that if you hold it up to your ear can sing to you with a loved one’s voice, but if you look at it with your eyes, can show you a corrupted human with bleeding orange skin scream the profane with a thousand voices. The other day I saw someone hack a moving vehicle. At one point they made it stop. At another they made it so it couldn’t stop. Some of our best and brightest are going to create an army of four winged bats hovering throughout every city and we are going to connect them directly to the dimension where the nightmares live.

I’m not saying it’s all bad, but I am saying Cthulhu lies deathless dreaming in this web we built him and he is waking up.

if you’ve spent your adolescence in the darker and more profane areas of this web you sure as hell don’t develop normal human appetites, that’s for damn sure. you wind up with a hunger for a lot more tentacles than humans are normally equipped with. 

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20 hours ago
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Here Are The Media Hottakes We’d See If The Chronicles Of Narnia Were Released This Year

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The press has certainly taken its lumps lately—and they’re not altogether undeserved. As Federalist contributor Tom Nichols points out in his new book The Death of Expertise: The Campaign Against Established Knowledge, a great deal of journalism currently exists more to confirm its audience’s preconceived notions than to inform them about reality.

Nichols’ book inspired me to reflect on how politically obsessed and ideologically sequestered our press has become, particularly when it comes to hot-button social issues.  To illustrate this, let’s take the debate into the world of counterfactuals: in the alternate history where C.S. Lewis’ classic children’s fantasy series is released this year and becomes a mega-hit, I think the hot takes would probably look something like these. 

The American Conservative: “Narnia and the Problem of Borders”
By not effectively maintaining border security, King Tirian ensured his nation would be invaded and plundered by the Calormenes. Also, Archenland should’ve been Narnia’s Benedict Option.

The Atlantic: “How World War II Shaped Narnia”
One of those very comprehensive and thoroughly researched articles that’s so long it’s divided up by roman numerals. It’s fascinating, but you have to go to class at some point. Most of your social media friends will share this article after reading about a third of the way through, and nod sagaciously when asked about it.

Breitbart: “Narnia Ignored Calormene Jihad, Innocent People Died”
The nation should’ve gotten smart and gotten tough. Also, Soros would’ve funded the Calormenes.

BuzzFeed: “20 Times Eustace and Jill Almost Kissed”
A series of GIFs with inconsistent formatting obviously poached from Tumblr. About ten of them can be viewed as vaguely romantic, if you stretch the definition.

The Federalist: “17 Reasons Puddleglum Is The Most Hopeful Character In Literature”
We promise, there really is something good to be found in bottom-feeder mass-market material. Also, it has something to do with sex, gender, and Alexis de Tocqueville. Can’t we get that in the title?

First Things: “Cair Paravel Against the World”
In the face of mounting cultural opposition, “Narnia” shows us how to preserve our institutions. Also, Pope Francis really needs to clarify his stance on animal souls.

Huffington Post: “Nevertheless, Lucy Persisted”
Despite her brothers’ attempts to mansplain away what she found in the wardrobe, Lucy kept talking and ended up the Queen. (Hillary Clinton won the popular vote, by the way).

Mother Jones: “Why the Dwarfs Must Always Be for the Dwarfs”
In the face of unprecedented Narnian and Calormene labor exploitation, the Dwarfs of King Tirian’s Narnia retained solidarity. American workers must follow their example.

Jezebel: “Susan Pevensie and Internalized Misogyny”
She starts wearing lipstick and gets kicked out of Narnia? Talk about patriarchy!

MTV News: “New Years’ Resolutions for C.S. Lewis”
Ugh, white dudes, I can’t even. Here’s some Beyoncé instead.

National Review: “The Left’s Britain Problem”
Liberals are criticizing “Narnia” because they hate that the books draw upon a distinctly Burkean, Anglo-Saxon intellectual heritage. Also, Trump doesn’t understand that heritage.

New York Times: “Amid Online ‘Narnia’ Outcry, Trump Is Silent”
The article opens with a scowling picture of the President, with Sean Spicer or Jared Kushner out-of-focus behind him. Paul Ryan is blamed for not speaking up about the “Narnia” controversy. Someone from the Center for American Progress will be quoted.

The New Yorker: “Kellyanne Conway, Our White Witch”
Just as Jadis presided over the destruction of Charn, so too will Conway preside over the destruction of the American Republic (“Trump,” after all, is the new Deplorable Word). There will also be at least two references to French writers you’ve never heard of.

Patheos: “Are We All Aslan Now?”
If we can really reach inside ourselves, beyond the false dilemmas presented by the Religious Right, we can realize that we too are Aslan, armed with the courage of lions to speak truth to power.

U.S. News and World Report: “The 10 Best College Fantasy Literature Programs”
Paywalled.

Reason: “Narnia Doesn’t Need Kings”
In “Prince Caspian,” the Telmarines were on the cusp of transforming Narnia into a successfully modern state that would’ve created job opportunities for everyone. Aslan’s violent return destroyed valuable capital and plunged the regime back into a preindustrial dark age. The GDP losses are incalculable. For shame, Aslan.

Rolling Stone: “A Swordfight on Campus”
[Retracted: This story erroneously alleged that C.S. Lewis intentionally promoted school violence in the closing pages of “The Silver Chair.” We regret the error, and will be ordering a full investigation.]

Salon: “With ‘Narnia,’ the Publishing World Takes Steps Toward Normalizing Mike Pence’s Theocracy”
Narnia is ruled by monarchs appointed directly by a deity, and that’s precisely how the Trump White House sees itself. And what’s Aslan’s position on reproductive rights? These questions need answers.

Slate: “Narnia’s White Savior Problem”
The Pevensie children are colonial occupiers of a foreign regime, and should’ve used their talents to center the voices of Narnia’s native inhabitants. Also, the interracial romance in “The Horse and His Boy” is really, really problematic, if you think about it.

Vox: “What you really need to know about Narnia author C.S. Lewis”
Did you know that C.S. Lewis also wrote a series called “The Lord of the Rings”? [Correction: This story meant to state that C.S. Lewis wrote a series called “The Space Trilogy”].

WorldNetDaily: “You’ll Never Guess What Books Obama Wants to Ban”
President Obama once said he thought “Holes” was his favorite young-adult book. Obviously, he’s planning to take Narnia out of school libraries across the country. Also, this event was foretold in biblical prophecy.

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The Impossible Politics of Medicaid Reform

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Medicaid is arguably the civilized world's worst health insurance program. And while the bulk of the commentarati has been fixated on reforming Obamacare'sPills exchanges, the far bigger political challenge will be dealing with the law's expansion of Medicaid.

This is a joint federal and state program even before Obamacare had become firmly entrenched in every state because the on average give states 50 cents for every dollar they spend on purchasing health coverage for the poor. Because of this federal largesse, Medicaid has grown astronomically, becoming the single biggest ticket item on virtually every state budget. But it's not just expensive — it provides lousy coverage, too!

Unfortunately, instead of fixing this terribly flawed program, President Obama essentially money-bombed states into expanding it even further. He offered to pick up 100 percent of the tab for the first three years for every additional person they covered up to 138 percent of the poverty level. After that, he'd taper it to 90 percent in perpetuity. Thirty-one states and the District of Columbia accepted the offer. But 19 states refused. Liberals will tell you that these GOP-run states are helmed by heartless monsters who don't care about the health of poor people. But the truth is that they just didn't want to be left holding the bag in case Uncle Sam reneged on Obama's unsustainable promise.

Of the 16.6 millions previously uninsured Americans who obtained ObamaCare coverage between December 2013 and September 2016, only a net of 2.8 million did so via private coverage, according to Heritage Foundation's Edmund F. Haislmaier. The balance — a whopping 13.8 million — got it through Medicaid and its companion program for children, called CHIP.

In total, Medicaid now covers almost 75 million Americans. And even before ObamaCare took effect, Medicaid paid for almost half of all births in America. That is stunning — and it's a number that has surely grwon post-Obamacare.

Medicaid's massive footprint would be acceptable if the program offered quality care at affordable prices. But it doesn't. The combined annual cost of the program now exceeds half a trillion dollars (with the feds' share at 63 percent and states' at 37 percent) — which adds up to roughly $7,000 for every man, woman, and child covered by the program. This is on par with the costs for private coverage. But do Medicaid recipients get comparable service? Far from it.

Several reputable studies have found that Medicaid patients experience no better health outcomes than uninsured people, and arguably even slightly worse outcomes. But the most stunning of all was a 2013 study on Oregon's Medicaid program co-authored by ObamaCare architect Jonathan Gruber of MIT. By luck, it was the closest thing in real life to a controlled experiment.

Here's what happened: Thanks to a budget crunch, Oregon was forced to rely on a lottery to distribute Medicaid coverage to 30,000 out of 90,000 applicants. These people were similar in every essential respect except that some got Medicaid and others didn't. Gruber compared the health outcomes of both groups and concluded that Medicaid "generated no significant improvement in measured physical outcomes" for diabetes, high cholesterol, high blood pressure, and even mortality rates. (Medicaid patients did report better mental health outcomes.)

Liberals claim that repealing ObamaCare will kill people. But at least as far as ObamaCare's Medicaid component is concerned, the opposite might in fact be closer to the truth.

Nor is it hard to understand why. Medicaid reimburses doctors so poorly that providers literally shun recipients. This means that Medicaid patients face far longer wait times to see primary care doctors, specialists, or get surgery. Often they end up in the emergency room just like the uninsured. And in non-emergency situations, the uninsured might in fact get better care than Medicaid patients because doctors have more flexibility to charge them market prices.

Clearly, the program is crying for radical surgery. And Republicans, to their credit, have some pretty decent ideas for how to perform it.

The leading GOP idea is to block grant Medicaid and give states an annual lump sum tied to inflation, basically ending the open-ended entitlement that's burning a hole in federal and state coffers. (Again, for most states, Medicaid is the single biggest — and the fastest growing — budget item.) Republicans would also get rid of the federal mandates that force states to offer a prescribed set of benefits and, instead, let them experiment with alternative arrangements. For example, states could offer beneficiaries the option of buying catastrophic coverage to guard against some unforeseen and costly illness and combine it with a Health Savings Account — basically a tax-free IRA — to pay for routine care and other out-of-pocket expenses. Any balance at the end of the year would roll over into the next year.

This arrangement would give patients a good reason to shop more prudently. Over a period of time, this would curb health care inflation and lower overall spending. The Congressional Budget Office has estimated that block grants could cut Medicaid spending by up to a third over a decade.

This is hardly a new idea. But the reason it hasn't gone anywhere is because liberals hate the notion of anything less than full-blown, guaranteed public insurance that in theory covers everything, never mind the sordid practical reality. But after ObamaCare, the politics of such reform are going to be even more intractable.

Here's why:

Essentially, if the block grant to each state is calculated based on its pre-ObamaCare Medicaid population, many of the newly covered would lose insurance, surely triggering a popular revolt. However, if the block grants were based on the post-ObamaCare Medicaid population, the 19 states that did the fiscally responsible thing and didn't sign up for ObamaCare's Medicaid expansion would be unfairly penalized. And given that all these states have Republican governors, GOP lawmakers on Capitol Hill would have to face the wrath not only of liberals but also their own party. It's hard to imagine President Trump, a man obsessed with polls, signing up for either of these outcomes.

The other alternative would be to give all states enough money to cover everyone at 138 percent of the poverty level. But this would mean that the GOP's repeal-and-reform would be even costlier than ObamaCare itself.

Republican Gov. John Kasich of Ohio, a Medicaid expansion state, has indicated that he would be willing to accept block grants covering only people up to 100 percent of the poverty level in exchange for more operational control. However, convincing dozens of other governors to go along with telling millions of Americans they no longer get Medicaid would be... an uphill task. Making things even more difficult: This would have to be settled before April so that it could be included in the budget reconciliation bill that Republicans want to push out before insurers finalize their 2018 plans for participating in ObamaCare.

ObamaCare is like a Rube Goldberg contraption. Taking it apart and reassembling it is easier said than done — even if it's the right and smart thing to do. And if Republicans can't figure out a way to do so, American patients and taxpayers will be the big losers.

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